Program helps rural Coloradans move past health barriers

There is nowhere Mark Davis would rather live than the mountains of Colorado.

Now 60 years old, Davis is a carpenter who specialized in remodeling houses in the Front Range and, later, in Grand County. For nearly 10 years, he lived near Grand Lake in an apartment with his dog, Patches.

But in his 50s, he began noticing that he had less control over his muscles and his speech. Davis was diagnosed with Parkinson’s disease, a disorder of the nervous system. “The tremors were getting worse,” he said. “Your whole body gets tired.”

Over time, his deteriorating muscle control made it nearly impossible to ride his bicycle or drive around, let alone do his work. “I can’t drive at all now,” he said.

Having lost his primary source of income, Davis didn’t have insurance to support his medical care, and without it, just one of the medications he needed to manage his Parkinson’s cost hundreds of dollars a month. For a person living alone and without insurance, the situation wasn’t easy.

A friend recommended that Davis get in touch with the Grand County Rural Health Network, a nonprofit founded 15 years ago that focuses on making sure that residents in this Western Slope county have access to health care.

The Grand County Rural Health Network’s staff helped Davis apply for Medicaid and Social Security Disability benefits. They also connected him with Maureen Wenger, a patient navigator who has been working with Davis for nearly five years. Wenger has done everything from accompanying Davis to doctor’s appointments to helping him find a spot at the Cliffview Assisted Living Center once it became too difficult for him to continue living alone.

In Grand County and throughout rural Colorado, Jennifer Fanning, the executive director of the Rural Health Network, says, “geography is the biggest social determinant of health.”

That shows up in a variety of ways. In Grand County, the eastern part of the county has a large number of jobs in ski tourism. The western part of the county has more ranchers. But all of those active lifestyles come along with high rates of injuries – and, often, with the instability of a seasonal income.

A higher percentage of rural Coloradans have incomes under the federal poverty line than urban Coloradans; a greater portion of children, in particular, live under the poverty line, according to the most recent Kids Count report.

In rural Colorado, many commodities and services — from groceries to daycare to housing — are scarcer and more expensive. There’s also a shortage in health care providers in many counties, including Grand County. That can make it especially difficult for patients on Medicaid to get appointments and care.

In 2014, Grand County had one of the highest rates of uninsured children in the state. The situation has improved since then, with the expansion of access to Medicaid and the introduction of the Affordable Care Act. But the Western Slope of Colorado has some of the highest insurance and health care costs in the country.

Another challenge: transportation. In Grand County, there’s very little public transportation in the county for residents like Davis who can’t drive. That makes getting to doctors’ appointments challenging. Long commutes from more affordable towns to work in the resorts in East Grand County can take a toll on one’s mental and physical health.

The Grand County Rural Health Network takes a variety of approaches to help rural residents’ health, all developed with the input of community members.

One program, the A.C.H.E.S. (Advocacy for Children’s Health and Education Services) and P.A.I.N.S (Partners for Adults in Need of Services) program, provided more than $25,000 in vouchers for acute and preventive health care in 2015. The county doesn’t have a low-cost health clinic for those without insurance, so the vouchers help uninsured adults and children access services.

A health care guide helps residents enroll in Medicaid or find insurance. And a growing program helps screen young children for developmental and health challenges and connects health records between providers.

The Rural Health Network’s patient navigator program teaches residents like Davis about their chronic diseases and helps them access the services they need to remain healthy.

The patient navigator program isn’t unique to Grand County. But in Grand County, the navigator – Wenger – also is a certified nurse. Fanning said that it’s more expensive to employ a nurse as a navigator. But she said that the value of having a nurse is evident in the Rural Health Network’s scores on the “Patient Activation Measure,” a commonly used tool for gauging patients’ knowledge, skills and confidence. Patients showed nearly a tripling in scores on measures such as empowerment and knowledge about their own health conditions after working with the nurse navigator. “Our nurse navigator has the ability to empower people,” Fanning said.

Another sign of success: In the Robert Wood Johnson Foundation’s rankings of the health in states around the country, Grand County’s rating went up – from 24th in the state in 2011, to 11th in the state in 2016. That change mainly reflects a reduction in preventable hospital stays and a drop in uninsured rates – both outcomes of programs the Rural Health Network is focused on.

For Davis, managing his health is an ongoing project. A recent change in medication left him concerned about tremors again. It can be difficult to schedule appointments with high-quality providers who are accepting Medicaid at a time when he can also find transportation.

But he is glad to be in Grand County, where he can still see the mountains. “I love the pace,” he said.

And he says the Rural Health Network has been an important part of allowing him to stay. “It’s great to have these guys in your corner,” he said. “It really makes a big difference.”